Questions about Insurance Coverage

Q:  Does my insurance cover the Adjustable Gastric Lap Band?

A: The best way to determine the answer to that question is to contact your insurance company Member Services Department.  The number is usually listed on your insurance card. 

Ask them specifically:   

"Does my plan cover weight loss surgery with the Lap Band®?" 

The procedure code for insurance billing is 43770.

Q:  What do I have to do to get approval for the Lap Band® Surgery?

A: Insurance companies vary on their requirements for pre-determination of coverage in order to approve your surgery.  The surgeon’s office may be able to provide you with the specific requirements for your plan, but you should also contact your insurance company and obtain these requirements as they change frequently.  Most insurance companies now list these requirements on their website. You may have to obtain records from your primary care doctor and other specialists.  In addition, you may be required to see a nutritionist and/or have a psychological evaluation prior to the surgery.   

Q:  Why does the insurance company want this information?

A:  The insurance companies are attempting to see that you can stick to a diet plan and that you are in the best possible health for surgery.  They also want to see that you have made a concerted effort to lose weight on your own and been unable to sustain any substantial weight loss, making surgery your only option.

Q:  What if I don’t have the weight loss history?

A:  If you have not gone to a physician in an effort to lose weight, you will have to take time out and create that history.  Insurance companies are adamant about having that documentation and will not approve anyone for surgery without it.  The best thing to do is to talk to your primary care physician about putting you on a diet plan, exercise regimen and work on behavior modification.  Make sure your physician documents these discussions in great detail.  The insurance companies are very particular about this documentation.  The surgeon’s office can assist you further with these requirements at your consultation visit.

Q:  How is the information gathered and submitted?

A: After obtaining a list of your insurance company’s requirements, it is your responsibility to get this information to the surgeon’s office.  When all items have been received, we will send a letter of pre-determination to your insurance company along with the required records.  

Q:  How long does it take to get approved?

A: Most insurance companies take 30 to 60 days to go through the approval process.  Typically they will send a letter to the office and to the patient informing them of their decision.  We contact you as soon as we hear from your insurance company.  We request that you start calling your insurance company approximately 3 weeks after we submit everything to check the status of our request. The insurance companies typically respond to their members much more promptly than they do the doctor’s office.

Q:  What will I have to pay for this surgery if my insurance covers the procedure?

A: Dr. Collier’s staff can discuss fees and payments with you.  Payments are calculated using your network benefits.  Your out of pocket expenses will be calculated for you prior to surgery.      

Q:  How do I qualify for this surgery?

A: The general rule of each insurance company is that your BMI must be 35 or greater with additional severe co-morbidities such as, Hypertension, Sleep Apnea, Coronary Heart Disease, Diabetes, and GERD; or your BMI must be 40 or greater without any additional co-morbidities.